Why the study?
Do new oral anticoagulants and extended thromboprophylaxis policies improve outcomes in patients undergoing hip and knee arthroplasty compared to LMWH or other policies?
Do new oral anticoagulants and extended thromboprophylaxis policies improve outcomes in patients undergoing hip and knee arthroplasty compared to LMWH or other policies?
In a large observational cohort of hip and knee arthroplasty patients, NOACs and extended thromboprophylaxis showed no significant outcome differences compared to LMWH, supporting surgeon discretion in prophylaxis choice.
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Observational data on post-arthroplasty thromboprophylaxis should not change practice; leaves open optimal NOAC duration and safety.
The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements. There were no differences in outcomes for either LMWH or NOAC. We found no advantage in favor of any single anticoagulation policy or in changing policy. This study supports the American Academy of Orthopaedic Surgeons' recommendation that the choice and duration of thromboprophylaxis prophylaxis be decided by the treating surgeon.
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Bottle et al. (2015) studied this question.
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